Leishmania donovani: an opportunistic microbe associated with progressive disease in three immunocompromised patients.

Three cases are described showing that Leishmania donovani can cause progressive disease in immunocompromised hosts. The first patient was receiving corticosteroid therapy for ulcerative colitis and the second corticosteroids and cyclophosphamide for proliferative glomerulonephritis; in the third patient, leishmaniasis occurred after a long episode of hepatosplenic schistosomiasis and salmonella bacteraemia which was treated with chloramphenicol. In two cases, the patients had moved away from areas of L donovani transmission many years before the progressive disease occurred, consistent with long-term survival of the organism in normal hosts. L donovani should be added to the growing list of opportunistic microbial infections.